Jurnal Aisyah : Jurnal Ilmu Kesehatan

Volume 5, Issue 1
1, June 2020, pp. 93 – 96
ISSN 2502-4825
4825 (print), ISSN 2502
2502-9495 (online)

Descriptive study of anxiety among chronic kidney disease patients

underwent hemodialysis: Pilot study
Rokhmat1*); Achmad Zulfa Juniarto2; Chandra Bagus Ropyanto3
1*, 2, 3
Universitas Diponegoro Semarang

ARTICLE INFO ABSTRACT

Chronic kidney disease is a kidney organ disease that cannot be cured, has
Article history: been suffering for the whole life of the patient and must depend on a
kidney function replacement device to maintain the sufferer life. Patients
Received December 04, 2019
Accepted February 12, 2020 who have experienced chronic kidney disease undergoing hemodialysis are
Published June 05, 2020 difficult to cure and become a major problem for the world,
world especially the
problem of the treatment costs are relatively expensive. Health conditions
that are experienced is a crisis situation that can cause psychological
Keyword: disorders. Psychological problems which often arise in patients with
Anxiety chronic kidney disease is anxiety. This study aims to determine the anxiety
Chronic kidney disease of chronic kidney patients undergoing hemodialysis at Batang Regional
Hemodialysis Public Hospital (RSUD). This research type is qualitative research with a
descriptive method of phenomenology. The subjects in this study s were
patients with chronic kidney disease who underwent hemodialysis at
Batang Regional Public Hospital (RSUD). The technique used in taking
participants using purposive sampling with the number of 5 participants.
Data collection techniques in this study udy used structured interviews about
anxiety in 3 aspects, namely physiological, psychological and affective
aspects. Data analysis was performed by data reduction, triangulation and
drawing conclusions. The results obtained in this study there are 3 aspects
aspec
of anxiety experienced by participant namely physiological, psychological,
and affective aspects. In the physiological aspects of patients complaining
that it was difficult to sleep, in the psycho-psychological
psychological aspect, the patient
still felt afraid of the
he affective aspects of the patient complaining of
decreased patience and tension before hemodialysis.

This open access article is under the CC–BY-SA license.

Studi deskriptif kecemasan pasien penyakit ginjal

kronik yang menjalani hemodialisa: Pilot study
ABSTRAK
Kata kunci: Penyakit ginjal kronis merupakan penyakit pada organ ginjal yang tidak
Kecemasan dapat disembuhkan, diderita seumur hidup pasien dan harus bergantung
Penyakit ginjal kronik dengan alat pengganti fungsi ginjal guna mempertahankan kehidupan
Hemodialisa penderitanya. Pasien yang sudah mengalami penyakit ginjal kronis yang
menjalani hemodialisa sulit untuk disembuhkan dan menjadi masalah
besar bagi dunia, terutama masalah biaya perawatan dan pengobatannya
*) corresponding author yang relatif mahal. Kondisi kesehatan yang di alami merupakan sebuah
Mahasiswa Program Studi Magister
krisis situasi yang dapat menyebabkan
abkan gangguan psikis dan psikologis.
Keperawatan Universitas Diponegoro Permasalahan psikologis yang sering muncul pada pasien penyakit ginjal
kronis adalah kecemasan. Penelitian ini bertujuan untuk mengetahui
Email: rokhmatbtg65@gmail.com kecemasan pasien ginjal kronik yang menjalani hemodialisa di RSUD
Batang. Jenis penelitian yang digunakan adalah penelitian kualitatif dengan
DOI: https://doi.org/10.30604/jika.v5i1.262 metode deskriptif femomenologi. Subjek dalam penelitian ini adalah pasien
penyakit ginjal kronik yang menjalani hemodialisa di RSUD Batang. Teknik

Available online at: https://aisyah.journalpress

aisyah.journalpress.id/index.php/jika/
Email: jurnal.aisyah@gmail.com
jurnal.aisyah@
 Jurnal Aisyah: Jurnal Ilmu Kesehatan, 5(1),
5 June 2020, – 94
Rokhmat; Achmad Zulfa Juniarto; Chandra Bagus Ropyanto

yang digunakan dalam pengambilan partisipan men menggunakan

ggunakan purposive
sampling dengan jumlah partisipan adalah 5 partisipan. Teknik
pengambilan data dalam penelitian ini menggunakan wawancara
terstruktur tentang kecemasan dalam 3 aspek yaitu aspek fisiologis,
psikologis dan afektif. Analisa data dilakukan dengan melakukan reduksi
data, triangulasi dan menarik kesimpulan. Hasil yang diperoleh dalam
penelitian ini ada 3 aspek kecemasan yang dialami partispan yaitu aspek
fisiologis, piskologis, dan aspek afektif. Pada aspek fisiologis pasien
mengeluhkan sulit untuk tidur, pada aspek psikoogispasien masih merasa
takut pada aspek afektif pasien mengeluhkan penurunan kesabaran dan
tegang sebelum tindakan hemodialisa.

This open access article is under the CC–BY-SA license.

Introduction

Chronic Kidney Disease (CKD) is a process in which the
kidneys suffer damage that spans more than three months
(Muhamad, 2014). Patients with chronic kidney disease
according to data from the Global Burden of Disease 2010,
CKD was ranked 27th in the list of causes of the number of
deaths worldwide in 1990, but rose to 18th in 2010. In 2017
it was shown as the cause of death in the 16th sequence.
CKD incidence in Indonesia based on Baseline Health
Research (Riskesdas) data in 2018 was 19.3%. The number of
CKD incident in Central Java showed an increase in 2,488
new patients (PERNEFRI, 2017). One of the hospitals which
have hemodialysis services in Central Java, especially at
Batang Regency is Batang Regional Public Hospital (RSUD).
Based on data from Batang Hospital there is an increase in
the number of CKD patients in September to December,
ecember, from
364 to 411 patients undergoing hemodialysis.
Patients with chronic kidney disease who have entered
the End Stage Renal Disease (ESRD) stage must undergo a
kidney replacement therapy program, one of which is
hemodialysis which is carried out routinely outinely and
continuously. This will cause the patient to experience
various physical effects that are often felt by patients with
chronic kidney disease including fatigue, muscle cramps,
shortness of breath, pain, sexual disorders and insomnia.
These effects
cts can cause psychological symptoms that are
mostly experienced by CKD patients undergoing
hemodialysis, namely anxiety that can reduce their life
quality (Goh and Griva, 2018)
Anxiety is an individual's response to an unpleasant
situation experienced by everyone in daily life. Patients with
chronic kidney disease are dealing with many stressors, such
as loss of kidney function, development of digestive and
neurological diseases, bone disease, anemia, unable to play a
normal role in the family and work, decreased
creased physical and
cognitive strength and loss of sexual function (Semaan,
2018). Except for internal stressors, patients also experience
anxiety related to changes in life quality caused by treatment
change from conservative to hemodialysis treatment.
Anxiety
nxiety is one of the things which often complained by
patients undergoing hemodialysis. The anxiety experienced
by patients arises because of the very long-suffering
suffering period.
In addition, hemodialysis patients often think negatively of
the hemodialysis processess that they do for a long time. This
situation can cause changes to patients, not only physical but
psychological. The process of invasive action is one of the
situational factors related to anxiety (Hsu, 2015)
Several previous studies stated that CKD patients pa
undergoing hemodialysis experience anxiety. Based on study
conducted by Chen, et al.. in 2010, 200 patients with
hemodialysis were obtained 35% had anxiety, 21.5% had
depression. This is supported by the results of a study
conducted by Lamusa, et al in 2015 explaining that of 189
CKD patients undergoing hemodialysis programs had severe
anxiety 79 people (34.2%), moderate anxiety 68 people
(29.4%) and mild anxiety 42 people (18.2%).
Nurani research results explain that chronic kidney
failure patients undergoing
ndergoing hemodialysis will experience
changes in their lives both in terms of psychological,
financial, physical and social aspects. Under these conditions,
the patient will interpret his life so that his life is still useful,
valuable, and meaningful. The e ROEM study (2015), mentions
that patients undergoing hemodialysis experience moderate
anxiety and still have good life quality.
Based on these matters, the researchers are interested in
conducting research on anxiety in patients undergoing
hemodialysis att Regional Public Hospital Batang because this
anxiety is often experienced by patients undergoing
hemodialysis. The purpose of this study was to determine
the anxiety of chronic renal failure patients who underwent
hemodialysis for the first time at Batang g Regional Public
Hospital based on physiological responses, psychological
responses, and affective responses of patients.
Method
This research uses qualitative research. The research
design used by the researchers is descriptive
phenomenology that understands the world phenomenon
uniqueness of individual life, unique and specific responses
experienced by each individual to further explore the
phenomenon meaning. The data collection technique uses
semi-structured
structured interviews by using interview guidelines
g
that include three aspects of anxiety, namely anxiety in
physiological aspects, anxiety in psychological aspects and
anxiety in affective aspects.
In physiological aspects, the questions related to anxiety
disorders experienced by patients physicallyphysic during
hemodialysis such as sleep disorders, eating disorders, etc. In
the psychological aspects of the patient's anxiety examined
related to psychological problems during hemodialysis such
as fear, anxiety, etc. In the affective aspect, questions focus
foc

Jurnal Aisyah: Jurnal Ilmu Kesehatan ISSN 2502-4825

4825 (print), ISSN 2502-9495
2502 (online)

more on the patient's emotions such as anger, patience in
deal with temptations, etc.
The descriptive phenomenology design has the aim of
describing, interpreting and analyzing data in depth,
complete and structured to obtain the essence of life
experience in the form of stories, narratives and languages of
each individual. Participants in this study were 5 patients.
The sampling technique in this study is using purposive
sampling.
The place of this study is located in Batang Regional
Public Hospital, is a type C hospital that provides
hemodialysis facilities. The room used in the interview
process is the hemodialysis room at Batang Regional Public
Hospital (RSUD). This study was conducted in September
2019. The researchers conducted interviews with
participants after obtaining a research permit from the
hospital. The researchers record the interview results with
participants using a tape recorder. Then the interview results
from the tape recorder transcript the data into writing. Then,
the researchers analyze the data and determine the
interview results keywords to be the results theme of the
conducted interview.
Results and Discussion
Participant Characteristics
Participants characteristics showed that most
participants aged 50-65 years. Increasing age will affect the
anatomy, physiology and cytology of the kidneys.
Participants characteristics according to gender are
mostly male. This is consistent with Desi's research (2014)
that research conducted at PKU Muhammadiyah Hospital in
Yogyakarta took respondents from all patients undergoing
hemodialysis at the hospital, which consisted of 30
respondents, where males amounted to 21 patients and
females totalled 9 patients.
Participants characteristics according to their education
level are in junior high school. A person's education level is
related to a person's ability to understand health
information.
Patient's anxiety
Based on the result of the interviews conducted by the
researchers, it was obtained 3 themes of anxiety responses
experienced by patients undergoing hemodialysis at Batang
Regional Public Hospital. The 3 themes are :
Patient’s anxiety on physiological aspects
The results of interviews conducted with 5 participants
found that participants said they had sleep disorders. The
following are the results of interviews with participants:
"... yeah, sometimes sleep restlessly, often awakens (P1)
"... because I have this disease, it keeps on my mind, so I
can't be restful when I sleep (P3)
"... Yeah, sometimes can't sleep if I want to undergo
hemodialysis tomorrow ... because I'm worried (P5)
Descriptive study of anxiety among chronic kidney disease patients underwent hemodialysis: Pilot study
Jurnal Aisyah: Jurnal Ilmu Kesehatan, 5(1), June 2020, – 95
Rokhmat; Achmad Zulfa Juniarto; Chandra Bagus Ropyanto
Patient's anxiety on psychological aspect
The results of interviews conducted with 5 participants
found that the participants said if despite undergoing a long
period of hemodialysis, they still had a feeling of fear while
undergoing hemodialysis. The following are the interview
results with participants:
"... just afraid, even though I have often undergone
hemodialysis (P2)
"... Yeah, what should I do ...there is fear, especially if I
want hemodialysis (P4)
"... honestly ... I'm still afraid even though I'm used to it
(P5)
Patient's anxiety on affective aspect
The results of interviews conducted with 5 participants
found that the participants said they were tense and
sometimes felt impatient. The following are the interview
results with participants:
"I was feeling tense ... and it felt like I always wanted to
be angry, wanted to finish quickly (P1)
"What should I do ... a sick person is definitely impatient
(P2)
"... Yes, that's how it is ... can't wait, there is a sense of it ...
I want to get angry too ... especially in tense ... (P5)
Patient Anxiety on Physiological Aspects Overview
An overview of patient anxiety in terms of physiology
there is physical changes in the patient in the form of sleep
quality change.
The study shows that one of the emergences of anxiety
from physiological aspects is that there are participants who
have difficulty sleeping but there are also participants who
can sleep well before undergoing hemodialysis. The
participants' ability to stay asleep shows that anxiety that
occurs is not acute because it does not affect the brain work.
Carney and Edinger suggested that sleep disorders are not
only a sign of anxiety reactions but also a sign of severe
anxiety and depression (Jangkup, 2015)
Patient Anxiety on Psychological Aspects Overview
An overview of the patient's anxiety on the psychological
aspect is reviewed from the patient's feelings before
undergoing hemodialysis and the patient's acceptance of the
experienced hemodialysis conditions.
On the interview results, there was the data analysis
showed that anxiety on the psychological aspects of the
participants who felt afraid when undergoing hemodialysis.
The fear experienced by the participant is caused by the
participant who will undergo an invasive procedure as the
process of hemodialysis. Fear is part of the anxiety
experienced by the patient.
Person psychological which diagnosed with chronic
kidney failure tends to stress directly related to all the
problems that must be experienced after knowing about the
kidney problems existence in him. Hidayat stated that the
treatment problem t of chronic kidney failure is a source of
 Jurnal Aisyah: Jurnal Ilmu Kesehatan, 5(1), June 2020, – 96
Rokhmat; Achmad Zulfa Juniarto; Chandra Bagus Ropyanto

psychological responses in the form of internal stressors
(Jangkup, 2015)
Patient Anxiety on Affective Aspects Overview
An overview of patient anxiety on the affective aspect
can be seen from the attitudes change and participants'
behaviour before the hemodialysis process. Affective aspects
include patient patience.
Based on interview results and an overview analysis of
patient anxiety in terms of affective which arises is there are
some patients who experience changes in the patience level.
Patients with chronic kidney failure who choose
hemodialysis as a substitute therapy for kidney function will
undergo the therapy for the rest of their lives unless the
patient undergoes a kidney transplant.(10) The dependence of
chronic renal failure patients on hemodialysis for the rest of
their lives will have a wide impact and cause problems both
physically, psychosocially, and economically. The complexity
of the problems that arise in patients with chronic kidney
failure undergoing hemodialysis will effect in anxiety where
the patient will experience impatience and will be easily
upset (Smeltzer, 2009).
The emergence of treatment uncertainty experienced as
well as the disruption of the patient's lifestyle causes the
patient to feel depressed so, one of them causes the patient's
level of patience to decrease. While Jangkup explained that
the emergence of changes in patience and tension in patients
with kidney failure is an invasive process experienced by
patients during treatment or hemodialysis. The patient's
need for the hemodialysis process causes the patient to
demand more attention from the family so, the quality of
their health becomes better if do hemodialysis immediately
(Rahardjo, 2009).
Conclusions and Recommendations
The conclusion in this study found that anxiety of
chronic kidney failure patients undergoing hemodialysis at
Batang Regional Public Hospital from physiological aspects
was shown by the presence of insomnia behaviour. The
anxiety of chronic kidney failure patients undergoing
hemodialysis at Batang Regional Public Hospital from
psychological aspects showing that patients were in fear and
patients' anxiety with chronic kidney failure who underwent
hemodialysis at Batang Regional Public Hospital from the
affective aspect was the decreased level of patients' patience.
Suggestions for other researchers are expected to be able
conducting other studies in patients undergoing
hemodialysis not only limited to the description of anxiety.
But it can provide alternative interventions that can be used
to reduce anxiety in patients undergoing hemodialysis.

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Jurnal Aisyah: Jurnal Ilmu Kesehatan ISSN 2502-4825 (print), ISSN 2502-9495 (online)